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Siebel Insurance Guide > Managing Claims >
About Managing Reserves
An adjuster uses the Claims, Financials, and then the Reserves view to:
- Open reserves
- Adjust reserves
- Delete a reserve created using the Create Reserve button in the Loss Details - Auto or Loss Details - Property view
- Create new reserves
Opening Reserves
To open a reserve, the adjuster enters the amount of reserve to open in the Reserve Amount field and clicks the Open Reserve button. Siebel Insurance then performs the following checks:
- Reserve authority limit check. Siebel Insurance checks the user limit on a per reserve - per claims basis. For example, if adjuster A has a bodily injury limit of $20,000 and he would like to open bodily injury for contact 1 for $15,000 and bodily injury for contact 2 for $15,000, Siebel Insurance displays an error message since the $30,000 is more than the adjuster total bodily injury limit for the claims. The per reserve - per claim basis will apply at the supervisor level as well. That means if the claim goes to a supervisor, the amount will go against that supervisor limit even if he does not approve it. For example in, let's say B (A's supervisor) limit for bodily injury reserve is only $25,000. In this case, B can not approve it and Siebel Insurance will send the claim to C (B's supervisor). The next time A would like to open another bodily injury reserve, B cannot approve it anymore since the total bodily injury for the claim is already more than $30,000 and this is more than B's bodily injury $25,00 limit. A supervisor can click one of the reserves in the Inbox list to open a reserve, as long as his or her own limits are not exceeded. On the reserve applet, the approver only sees that associated reserve record. To see all of the reserve records, the approver can use the query button to show all reserves. From the inbox, a supervisor can change the reserve status to either approve or reject. Once a supervisor has changed the status of an Inbox item, the associated reserve status is changed and the item is moved to the completed inbox. Because the approval history is tracked by inbox items, administrators must not delete completed inbox items. For more information about using the Inbox, see Siebel Applications Administration Guide.
- The reserve authority limit check
- Split limit check. Siebel Insurance checks the individual policy limit and the total policy limit fields and does some comparison. If the reserve amount set for a contact or an account is more than the individual limit, Siebel Insurance displays an error message. Also, if the reserve amount set for a particular coverage is more than the total limit, Siebel Insurance displays an error message. For example, a Bodily Injury coverage can have a $100,000 individual limit and $300,000 total limit. Siebel Insurance checks that the reserve amount to be opened for each individual or account for the Bodily Injury reserve is no more than $100,000 and that the total reserves amount for bodily injury reserves for all individuals or accounts is no more than $300,000.
After the checks are performed, The Outstanding Reserve field is updated with the amount that was entered in the Reserve Amount field. For more information about financial limits for adjusters, see Administering Adjusters' Financial Limits. Table 9 shows the fields in the Reserves applet.
Table 9. Reserve Fields
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Status |
The status of the reserve. If the reserve status is Open, the reserve record is read only and the only way an adjuster can modify this record is by clicking the Reserve Adjustment button. |
Reserve Code |
The code of the reserve. |
Reserve |
The name of the reserve. |
Reserve Amount |
The reserve amount. The adjuster can enter the amount of reserve in this field. If the reserve type is Factor, this field is automatically prefilled. |
Reserve Type |
The type of the reserve such as Factor, Manual, or Calculated. |
Reserve Open |
The date the reserve is opened. |
Reserve Closed |
The date the reserve is closed. |
Outstanding Reserve |
The amount of reserve outstanding at a particular time. The value of this field is automatically decreased every time an adjuster makes an indemnity payment. |
Last Name |
The last name of the contact for which the reserve is opened. |
First Name |
The first name of the contact for which the reserve is opened. |
Account |
The name of the account in which the reserve is opened. A reserve can only be opened for either a contact or account and cannot be opened for both. |
Individual limit |
The individual limit for a particular reserve for a particular contact or account. The individual limits for reserves of the same reserve code must be the same. If, for example, you have two bodily injury reserves of the same code, one for person A, and you specify an individual limit of $100,000 and on the other bodily injury for person B you specify an individual limit of $150,000, Siebel Insurance displays an error message. |
Total Limit |
The total limit for a particular reserve. The total limits for reserves of the same reserve code must be the same. |
Deductible |
The deductible for the reserve. The deductibles for reserves of the same reserve code must be the same. |
Adjuster |
The name of the adjuster to which this particular reserve is assigned. Different reserves can be assigned to different adjusters and only the assigned adjuster can open that particular reserve, therefore it is necessary to enter the adjuster name. |
Approver |
The approver name. Siebel Insurance automatically populates the approver name with the adjuster's supervisor name. For information about how the employee hierarchy is set to determine the supervisor for each adjuster, see Administering the Employee Hierarchy. The supervisor can then go to the Inbox screen, drill down on the claims that need approval, and select the claim to open the reserve. The supervisor can change the status to either approve or reject. Once the status of the inbox is changed, items move to the completed inbox. If this supervisor does not have enough reserve limit, Siebel Insurance fills in the supervisor's supervisor name in the Approver field. Siebel Insurance then notifies that supervisor to go to the Inbox screen to approve the reserve. |
Insured property |
The insured property. |
Total payment |
The total amount of payment that has been made using this reserve. |
Adjusting a Reserve
After a reserve is opened, the user can adjust only the reserve amount by selecting the reserve record and clicking the Reserve Adjustment button. The user can then change the reserve amount and reopen the reserve. The adjuster can make the adjustment even after the reserve is used to make payment. When the adjuster makes a payment of type Indemnity, the value of the Outstanding Reserve field is decreased by the amount of the payment. If the Outstanding Reserve amount is 0, the adjuster cannot use this reserve to make other indemnity payments. If the adjuster wants to make indemnity payments, he must adjust the reserve amount by clicking the Reserve Adjustment button and entering the new reserve amount in the Reserve amount field. Siebel Insurance then updates the Reserve Outstanding field. Only the adjuster that is assigned to a reserve can open or adjust that reserve. An adjuster can assign a reserve to a different adjuster by changing the Adjuster field in the Reserves view.
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